# JOSEPH R. WALLER

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- **Entity:** Individual
- **Status:** Active
- **Sole proprietor:** No

## Provider details

- **NPI number:** 1689618852
- **Gender:** Man
- **Credential:** P.T.

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 225100000X | Physical Therapist | 6231-024 | WI | Yes |

## Other

- **Enumeration date:** 06/16/2006
- **Last updated:** 06/27/2013

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 27F99WA | BCBS OF MN | MN |
| 05 | — | 40319100 | — | WI |
| 01 | — | 42B57WA | BCBS OF MN | MN |
| 01 | — | 64-03552 | MEDICA | WI |
| 01 | — | 64-07247 | MEDICA | WI |
| 01 | — | 650023250 | RAILROAD MEDICARE/POPLAR | WI |
| 01 | — | 84251 | SECURITY HEALTH PLAN | WI |
| 01 | — | P00403685 | RAILROAD MEDICARE/NEW LONDON | WI |